Eicosanoid biosynthesis in patients with stable angina: Beneficial effects of very low dose aspirin

AbstractObjectives. We assessed the production of eicosanoids and the effects of very low dose aspirin in patients with stable angina under basal conditions and during rapid atrial pacing.Background. Platelet activation occurs in acute ischemic syndromes but is still controversial in stable angina. Very low dose aspirin is known to be platelet selective and can be used to test the hypothesis of the platelet origin of increased thromboxane production in stable angina.Methods. Urinary excretion of eicosanoids was measured in 42 patients, including 24 patients with and 18 patients without coronary artery disease. The effects of 50 mg/day of aspirin were measured at rest and during pacing-induced ischemia in 10 patients with stable angina and were compared with a similar group of patients not treated by aspirin.Results. Excretion of 11-dehydro-thromboxane B2was 2.6 times higher in patients with stable angina than in healthy subjects (mean [±SEM] 74.8 ± 13.0 [24 patients] vs. 29.0 ± 5.4 [18 patients] ng/mmol of creatinine, p < 0.01). Urinary prostacyclin metabolite levels did not differ between the two groups. Treatment for 8 days with 50 mg/day of aspirin inhibited platelet cyclooxygenase, as reflected by the 97% reduction of in vitro serum thromboxane production. This aspirin regimen normalized the level of urinary thromboxane metabolites in patients with angina (17.3 ± 3.4 ng/mmol of creatinine [10 patients], p < 0.001 from baseline level before treatment) and did not change prostacyclin metabolite levels. Atrial pacing in patients with angina not treated with aspirin caused lactate and thromboxane release into the coronary sinus. In patients with very low dose aspirin therapy, pacing did not cause thromboxane release despite inducing myocardial ischemia. However, fractional lactate extraction decreased less sharply in patients with than without aspirin therapy.Conclusions. Thromboxane production is greatly increased in patients with stable angina. Very low dose aspirin administered to these patients reduces thromboxane synthesis to normal levels, preserves prostacyclin biosynthesis and prevents acute thromboxane release into the coronary circulation during pacing-induced ischemia. Our data suggest that platelets (not monocytes/ macrophages) are activated in stable angina to produce thromboxane

Eptifibatide provides additional platelet inhibition in Non–ST-Elevation myocardial infarction patients already treated with aspirin and clopidogrel Results of the platelet activity extinction in Non–Q-Wave myocardial infarction with aspirin, clopidogrel, and eptifibatide (PEACE) study

AbstractObjectivesThe present study hypothesis was that eptifibatide offered further antiplatelet efficacy above clopidogrel in non–ST-elevation myocardial infarction (NSTEMI) patients before an expeditive coronary intervention.BackgroundAlthough thienopyridines and glycoprotein (GP) IIb/IIIa antagonists are often co-prescribed in the context of NSTEMI, the antiplatelet interaction of these agents is poorly described and the superiority of GP IIb/IIIa antagonists above thienopyridine treatment alone is not clear.MethodsThirty-two NSTEMI patients treated with aspirin and enoxaparin were studied using flow cytometry to define parameters of platelet activation with a panel of agonists before clopidogrel, after clopidogrel, and during an eptifibatide infusion following the clopidogrel load.ResultsAfter platelet activation with adenosine diphosphate, thrombin receptor-activating peptide, or U46-619, relative reductions in conformationally activated GP IIb/IIIa receptor expression (evaluated with PAC-1) of 48%, 43%, and 33%, respectively (all p < 0.0001), were seen with clopidogrel, but further 80%, 78%, and 72% (all p < 0.0001) reductions were seen with eptifibatide. With the same agonists, fibrinogen binding was significantly reduced after clopidogrel by 70%, 64%, and 81% (all p < 0.0001) and again further reduced with eptifibatide by 90%, 95%, and 69% (all p < 0.0001). The total number of GP IIb/IIIa receptors (measured as P2 expression) and P-selectin expression fell after clopidogrel, after ex vivo stimulation with the same agonists; however, both parameters increased slightly during the eptifibatide infusion.ConclusionsThe activated GP IIb/IIIa expression and fibrinogen binding findings indicate that eptifibatide provides significant potent antiplatelet activity above aspirin and clopidogrel, suggesting additive immediate protection in the treatment of NSTEMI. The P2 and P-selectin findings suggest the possibility of a partial agonist and/or pro-inflammatory effect

The ESCOMPTE Program: an overview

In this paper, the “Expérience sur Site pour COntraindre les Modèles de Pollution atmosphérique et de Transport d'Emissions” (ESCOMPTE) program is presented. The ESCOMPTE program is used to produce a relevant set of data for testing and evaluating regional pollution models. It includes high-resolution (in space and time) atmospheric emission inventories and field experiments, and covers an area of 120×120 km, centered over the Marseilles-Berre area in the southeast of France during Summer 2001. This region presents a high occurrence of photochemical pollution events, which result from numerous industrial and urban sources of primary pollutants. From the dynamical characteristics of the area, sea-breeze circulation and channeling effects due to terrain features highly influence the location of the pollutant plumes. ESCOMPTE will provide a highly documented framework for dynamics and chemistry studies.Campaign strategies and experimental set up are described. During the planning phase, existing modeling results helped defining the experimental design. The campaign involved surface measurement networks, remote sensing, ship-borne, balloon-borne, and airplane measurements. Mean standard meteorological parameters and turbulent fluxes, ozone, ozone precursors, photochemically active trace gases, and aerosols were measured. Five intensive observation periods (IOPs) were documented using a wide spectrum of instruments, involving aircraft (7) (one of them equipped with a Doppler lidar, the others for in situ meteorological and chemical measurements), constant volume balloons (33), ozone lidars (5), wind profilers (15 sodars and radars), Doppler scanning lidar (1), radiosonde systems (at 4 locations), instrumented ships (2). In addition to the air quality networks from environmental agencies, 15 supplementary ground stations equipped for chemistry and/or meteorology and/or surface flux measurements, were operational. All instruments were calibrated and compared during a Quality Control/Quality Assurance (QC/QA) week, at the very beginning of the campaign.Fifteen days were intensively documented during five IOPs, referenced as 1, 2a, 2b, 3, and 4. High pollution levels were encountered during sea-breeze conditions observed during IOPs 2b and 3, whereas IOPs 2a and 4 corresponded to moderate wind, and channeled plume regimes. In addition, hourly emissions inventories for all IOPs were established to complete data sets and to finalize the ESCOMPTE database (EDB).Two other projects were associated to ESCOMPTE: urban boundary layer (UBL) and tropospheric water vapor content by GPS tomography (GPS/H2O). They took advantage of the scientific environment provided by ESCOMPTE